Healthcare Provider Details

I. General information

NPI: 1922191626
Provider Name (Legal Business Name): OSCAR E TALLEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH STREET
AUGUSTA GA
30912
US

IV. Provider business mailing address

1499 WALTON WAY STE 1400
AUGUSTA GA
30901-2650
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2542
  • Fax: 706-721-6676
Mailing address:
  • Phone: 706-724-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number012975
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: